{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   L CRISLIP","gend":1,"add":"312 HORSESHOE CIR APT A04","city":"STUARTS DRAFT","state":"VA","zip":"24477-9998","dob":"1983-08-31","age":"","mstatus":"","insh":"7602782*01","cliId":"","pno":"540\/255-8039","cno":"540\/415-2062","email":"","ename":"","eno":"","pphy":"SNYDER, JOHN A DO","ppno":"540\/245-7870","pcpadd":"2570 STUARTS DRAFT HWY","pcpcity":"STUARTS DRAFT","pcpstate":"VA","pcpzip":24477,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/245-7871","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.12","G89.4","R10.9","M54.5","G89.29","NO DATA","R15.9","N39.46","N32.81","M54.6","F32.9","M54.2","R10.13","Z87.19","Z20.822","R10.2","M24.20","R10.84","R14.0","R51.","N39.0","N20.0","R82.994","K86.1","R39.15","F41.9","Z71.9","Z12.4","Z98.51","J40.","M79.2","N39.3","J06.9","Z03.818","M25.512","M47.812","F41.1","Z79.891","G89.18","Z20.828","Z96.0","Z00.00","F32.81","F39.","R21.","R10.31","R10.30","R30.0","G62.9","E55.9","H93.13","M51.36","M50.30","M51.34","R20.0","J02.9","K85.92","K66.0","R53.1","M40.294","K92.9","R63.4","Z90.3","Z98.890","N28.1","R10.10","R11.2","K58.9","R20.2","R10.33","L98.9","L98.8","M54.9"],"date":["2021-12-14","2021-05-21","2021-05-21","2021-08-27","2021-12-14","2021-05-21","2021-06-09","2021-09-28","2021-09-28","2020-01-14","2020-03-13","2021-11-10","2021-08-27","2021-10-05","2021-08-08","2021-10-05","2020-02-10","2021-12-17","2020-02-25","2020-05-26","2020-06-24","2020-07-20","2020-07-20","2021-03-16","2020-07-20","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-08-08","2021-08-27","2021-06-30","2020-06-02","2020-06-02","2021-12-14","2020-03-09","2020-10-07","2020-10-07","2020-11-12","2020-12-23","2021-06-30","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2020-06-24","2021-02-20","2021-02-20","2019-03-04","2019-03-04","2019-03-04","2019-03-06","2019-03-06","2019-03-06","2019-03-06","2019-09-13","2019-10-28","2019-10-28","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-11-04","2019-07-02","2019-08-27","2019-07-02","2019-01-28","2019-04-01","2019-05-14","2019-05-10","2019-08-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","","TOVIAZ","TAB 4MG","","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","68382018105","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","90","Select","Select",""],["","69784018014","POLYETH","POW 3350 NF","28","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","51672128401","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","68462013281","NORETH\/ETHIN","TAB 44581","21","Select","Select",""],["","00574011830","TROSPIUM","CAP 60MG ER","30","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","5","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","","PROCHLORPER","TAB 10MG","","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","51862006305","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","59746038210","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","20","Select","Select",""],["","69238105301","DESIPRAMINE","TAB 10MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","42543040701","POT  CITRATE","TAB 1080MG","90","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","60","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","300","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51248015052","VESICARE","TAB 5MG","30","Select","Select",""],["","60505470203","SOLIFENACIN","TAB 5MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}